One-on-One With Phill Wilson

Phill Wilson, founder and director of the Black AIDS institute, is a leader in the fight against HIV/AIDS in the Black community. Globally known and respected for his "tell it like it is" approach to combating the epidemic in Black America and abroad, Wilson sat down for a One-on-One with Associate Editor Keith Green to share his views on the plight of this disproportionately affected and infected population. What follows are highlights from that dialogue.

KG: What is your perspective on the state of African Americans as it relates to HIV/AIDS?

PW: In many ways, the issue around HIV/AIDS in Black America is a tale of two cities. On one hand, most of the data and information about HIV/AIDS as it relates to Black people in America is bad. No matter how you look at it, people of African descent in the United States represent a disproportionate amount of the HIV burden. We are roughly 12% of the U.S. population, yet we are nearly 50% of people living with AIDS in America today.

It is estimated that there are currently over a million people living with AIDS in this country. Over 50% of the new HIV/AIDS diagnoses in America are Black. When you look at the epidemic along gender, sexual orientation or age lines you find that, there again, Black people are being decimated by HIV/AIDS. Among women, 69% of the new HIV/AIDS cases are Black. Among young people, two-thirds of adolescent cases, between the ages of 13-19, are Black. The CDC recently released data suggesting that possibly 46% of Black men who have sex with men in America may already be HIV positive. So, from that lens, the news is bad.

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There are glimmers of hope, however, in that Black institutions are beginning to mobilize around HIV/AIDS in ways that we have not seen before. We have an increasing number of Black churches that are developing HIV/AIDS ministries. Black civil rights organizations are developing AIDS programming. Historically Black colleges and universities are beginning to teach HIV 101 on their campuses. Black fraternities and sororities are establishing activities to address HIV/AIDS. And women's organizations across the board are tackling this issue. So, the Black community is really poised to attack this problem full force and that's the good news.

KG: What factors play into those statistics?

PW: There are a number of factors that contribute to how African Americans are being impacted by HIV/AIDS.

One is obviously the economic disparities that exist in the U.S. that are based on race or manifest themselves along racial lines.

Number two is the under-utilization and under-access of medical care by African Americans.

Number three, obviously and probably the most important reason, is that the African American community was slow to respond to the epidemic, and as a result the virus had a chance to take hold in our communities, yielding a higher prevalence than in other communities. This slow response also resulted in the infrastructure and capacity of our community being totally insufficient to deal with this epidemic.

KG: Is there a unified response or plan of action?

PW: There is no unified response or plan, yet. However, developing a unified plan is critical and there are efforts being made to create one.

KG: What would that look like?

PW: I think that it would have to involve a number of components. First, there would have to be a cultural shift in our attitudes about HIV/AIDS. Meaning we have to establish a cultural norm where engaging in risky sexual behavior or risky drug use is just unacceptable.

We have to create an environment where people who are HIV negative have made a commitment that they are going to stay negative and people who are HIV positive have made a commitment that they are not going to engage in any behavior that would possibly transmit their virus to another person. Then we have to create community structures to support those kinds of commitments. That's number one.

Secondly, our institutions have to all include HIV/AIDS in their agendas ... the civil rights organizations, the fraternities and the sororities ... no matter what they are doing, AIDS needs to be a part of that agenda, because AIDS is so much more than just a health issue. It is a civil rights issue, it's an economic issue, it's an urban renewal issue, and it's a gender issue. So there are all of these other issues that are impacted by HIV/AIDS and, therefore, these other organizations need to take that on.

We also need to be aggressive in confronting stigma wherever we see it and let it be known that it is not acceptable. We need to make sure that people have the information that they need about HIV/AIDS. That they are encouraged to find out their HIV status and that they have access to the latest testing technology. People who are HIV positive must have access to care, minimally ... access to information about care options.

KG: What role does the Black church play in combating the epidemic?

PW: The Black church has always been an important institution in Black communities and I think that that is no different on this issue. Probably the area where the Black church can play the biggest part is in fighting stigma and by not contributing to it either on the basis of sexual orientation, which undermines prevention efforts, or HIV status.

Churches can show compassion, which can go a long way in creating a less judgmental environment where people are not afraid to deal with their HIV status. Also, churches should not back away from their traditional role of providing sanctuary, shelter, food and support for people in need.

KG: What are the major obstacles that prevent us from turning the statistics around?

PW: Clearly, the biggest obstacle is a lack of resources. The vast majority of organizations who are best positioned to turn those statistics around are wholly under-resourced. When I say resources I am speaking of both capital and technical. Not just technical in terms of computers and such, but technical in terms of epidemiology and those kinds of things.

KG: Black gay men are currently the hardest hit population in the country. What factors do you think play into that?

PW: Certainly, I think that stigma, demonization and marginalization contribute greatly to it. However, when you look at health indicators overall, Black men (Black gay men included) fare worse than any other population.

Even when you compare indicators by education, income and access to insurance, and then you compare young Black men to young Black women, you find that young Black women are doing much better than young Black men in all of those areas. And in the case of Black gay men, the lack of an infrastructure to really address the HIV/AIDS needs of young Black men speaks volumes about why we are having the problems we are having among this population.

The truth is that there is a community in our midst that is being devastated in ways that we are not seeing anywhere else on the planet!

KG: The CDC recently pulled together Black gay leaders from across the country in Atlanta to address this issue. What came out of that?

PW: Well, a number of recommendations have been made, not just to the CDC, but to all levels of government and to the community. There is a call for the President to focus on this issue by delivering a World AIDS Day speech on AIDS and Black men who have sex with men. There is a call for the President's HIV/AIDS commission to take up this issue at their next scheduled meeting. There is a call for [Health and Human Services] Secretary Mike Levitt to convene an African American summit to talk about the issues of Black MSMs (men who have sex with men) and rising AIDS case loads. We are also calling on Secretary Levitt to create an interagency task force so that all of the federal agencies can look at and figure out strategies to turn this number around. There is a call on the part of Congress to hold a Congressional hearing about this problem, led by the Congressional Black Caucus. We are urging the CDC to make a commitment to cut the incidence of HIV among Black men who have sex with men in half by 2010. So, there are lots of recommendations, but the question is who is going to hold the administration, the divisions, the departments and our elected officials accountable.

KG: How is the Black AIDS Institute addressing this issue?

PW: Two years ago BAI started Black gay men's programming, in an effort to mobilize Black gay men in the private sector to do things in their field. That program actually is starting to really take momentum. One of the things that we did in response to this data released in June is that we led the release of an open letter that was signed by over 50 Black gay leaders from around the country. What was important about that letter is that it wasn't just AIDS activists who signed it, but there were people who are involved in the arts, in entertainment, in business and in government, so that every aspect was represented in that letter. We had 50-plus Black gay men sign this letter and then distributed it broadly and advocate for Black institutions to pay attention to this issue, and not just as it impacts women and children.

KG: Over the next year or so what are some of our critical next steps as a people in general and, more specifically, as Black gay men at combating this epidemic?

PW: Well I think that the biggest thing is that we have to come up with a plan. A plan that is separate from whatever the government comes up with. That plan should lay out what role the government should play and, certainly in that mix, what role different agencies and levels of government can play. Right now the biggest next step is to get the word out, to raise awareness about the current state of affairs around AIDS in Black communities. Unfortunately, across all communities in the United States, people think that the AIDS epidemic is over. We need to find ways to "dis-infuse" them of that notion and to get them engaged in realizing the truth.

KG: Where do you see us as a people, 10 years from now as it relates to this epidemic? And if where you see us is not the same as where you would like to see us, give me some insight into that as well.

PW: Where do I see us? Well ... (long pause) ... unfortunately I don't see that we will have solved the AIDS problem by then, but what I would hope is that we have a robust infrastructure so that we are making steady progress towards stopping new infections and increasing access to and utilization of care, as well as being well on our way to establishing a culture where everyone knows their HIV status.

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